Health-related quality of life and cost after cervical spine trauma

Cervical spine trauma can have significant effect on patients' lives. The purpose of this study was to review the medical literature to determine the (1) number of studies reporting validated, standardized outcome measures to assess outcome after cervical spine trauma and (2) trends in outcome following surgical and nonsurgical treatment of cervical trauma. Information of each health-related quality of life (HRQoL) instruments including Short-form 36 (SF-36), short-form 36 veterans (SF-36V), short-form 12 (SF-12), short-form 6 disability (SF-6D), sickness impact profile (SIP-68), quality of well-being questionnaire self-assessment (QWB-SA), Qualiveen, and patient-reported impact of spasticity measure (PRISM) were reviewed. Twenty two papers with 8 instruments evaluated HRQoL of persons with SCI found to have lowered quality of life (QoL), especially in physical domain, compared with the general population. Factors related to negative results were age (more than 35 years old), gender (female), marital status (single), unemployment, injury pattern (Jefferson-type fracture) and patient with neuropathic pain. Regarding mental and social domain, results were also variable. Factors such as level of lesion (tetraplegia or paraplegia), completeness of SCI, and time since injury have not been consistently found to be associated with lower QoL. Complete tetraplegia was shown to have a higher cost of treatment. Further study is needed to evaluate quality-adjusted life years (QALY) of patients with cervical injury.     

Health-related quality of life after gastric banding

BACKGROUND: Bariatric surgery ameliorates obesity-associated diseases, resulting in psychological and social benefits. Long-term studies of its effects on quality of life (QOL) assessed with well established instruments are lacking. This prospective study investigated the long-term effects of gastric banding on health-related QOL using an obesity-specific validated measure. METHODS: The Health Related Quality of Life (HRQL) questionnaire was completed by 50 severely obese patients before surgery and at 1, 2.5 and 5 years after gastric banding. Ninety-eight subjects with normal weight, matched for age, sex and education, also completed the HRQL questionnaire as controls. RESULTS: Surgery was successful in all patients. Mean excess weight loss after 1, 2.5 and 5 years was 42.1, 42.2 and 41.6 per cent respectively. General wellbeing, health distress, depression, perceived attractiveness and self-worth improved significantly over the 5 years and, except for general wellbeing, were still improving after 5 years. There were increases in physical activity and work productivity. Successful weight loss was the main determinant of general wellbeing and health distress, and these were adversely affected by band-related complications. In subjects with a body mass index below 30 kg/m(2), scores improved to values for subjects of normal weight. CONCLUSION: Bariatric surgery resulted in sustained improvement in health-related QOL even though not all excess weight was lost. Normalization of health-related QOL may necessitate greater weight losses.     

Health-related quality of life after cardiac surgery

Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach.     

Health-related quality of life after radical cystectomy

Herein, we review the assessment of quality-of-life (QoL) in radical cystectomy (RC) patients, summarize the result of studies for different surgical approaches, and provide an overview of patient management, as well as other considerations. In this review article, we reviewed the QoL research and research tools for patients undergoing RC, including urinary diversion methods, gender differences, and surgical methods (open surgery vs. robotic surgery). This narrative review focused primarily on articles indexed in PubMed, Embase, Scopus, and Google Scholar databases. We did not used formal search strategy and meta-analysis was not performed.     

Health-related quality of life after prostate brachytherapy

Brachytherapy for prostate cancer has become a widely used treatment. Increasingly, urologists are becoming conscious of quality‐of‐life issues relating to treatment. This mini‐review by authors from the University of Virginia looks at this important issue, reminding readers that patients are often willing to choose a treatment which will less certainly ensure a longer life‐expectancy, but which will more certainly guarantee a better quality of life. Other mini‐reviews in this section describe the technique and complications of transurethral surgery for bladder tumours, the mechanisms of vasculogenic erectile dysfunction after renal transplantation, and laparoscopic radical cystectomy and urinary diversion.     

Health-related quality of life after hip replacement

Abstract Total hip replacement is widely known to be effective in the management of pain and functional status. Instead, less is known regarding patients perspective through the measurement of health-related quality of life. A retrospective study was conducted to evaluate patient-relevant outcomes in a homogeneous sample of patients who underwent total hip replacement. Long-term results were evaluated through a self-administered questionnaire and clinical examination. We were able to re-contact 84.8% of patients at the follow-up, at an average of 7.35 years. The results confirm the value of the treatment of hip arthritis, demonstrating the impact of hip replacement on physical function and pain and consequently on the improvement of quality of life.     

Health-related quality of life after osteoporotic fractures

Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55–75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score <–2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.     

Health-related quality of life in end-stage renal disease patients: the effects of starting dialysis in the first year after the transition period

Background/aims

Prevalent dialysis patients have low scores of health-related quality of life (HRQOL) which are associated with increased risk of hospitalization and mortality. Also in CKD-5 non-dialysis patients, HRQOL scores seem to be lower as compared with the general population. This study firstly aimed to compare HRQOL between CKD-5 non-dialysis and prevalent dialysis patients in a cross-sectional analysis and to assess longitudinal changes over 1 year after the dialysis initiation. Secondly, the correlation between HRQOL and physical activity (PA) was explored.

Methods

Cross-sectional 44 CKD-5 non-dialysis, 29 prevalent dialysis, and 20 healthy controls were included. HRQOL was measured by Short Form-36 questionnaires to measure physical and mental domains of health expressed by the physical component summary (PCS) and mental component summary (MCS) scores. PA was measured by a SenseWear? pro3. Longitudinally, HRQOL was assessed in 38 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before dialysis initiation until 1 year after dialysis initiation.

Results

PCS scores were significantly lower both in CKD-5 non-dialysis patients and in prevalent dialysis patients as compared with healthy controls (p?<?0.001). MCS scores were significantly lower in both CKD-5 non-dialysis patients (p?=?0.003), and in dialysis patients (p?=?0.022), as compared with healthy controls. HRQOL scores did not change significantly from the CKD-5 non-dialysis phase into the first year after dialysis initiation. PA was significantly related to PCS in both CKD-5 non-dialysis patients (r?=?0.580; p?<?0.001), and dialysis patients (r?=?0.476; p?=?0.009).

Conclusions

HRQOL is already low in the CKD-5 non-dialysis phase. In the first year after dialysis initiation, HRQOL did not change significantly. Given the correlation between PCS score and PA, physical activity programs may be potential tools to improve HRQOL in both CKD-5 non-dialysis as well as in prevalent dialysis patients.

     

Health-related quality of life after laparoscopic and open nephrectomy

BACKGROUND: Postoperative recovery often is assessed with parameters (pain and return to work) susceptible to bias. This study sought objectively to compare postoperative health-related quality of life (HRQL) after laparoscopic and open nephrectomy with the Postoperative Recovery (PRS) (a validated questionnaire designed to assess pain), activities of daily living (ADL), and HRQL in postoperative patients. METHODS: Patients undergoing contemporaneous laparoscopic and open nephrectomy received the PRS pre- and postoperatively. The results were analyzed with analysis of covariance (ANCOV) and survival analysis. RESULTS: The 33 open nephrectomy and 38 laparoscopic patients in this study were comparable in age, gender, body mass index (BMI) and employment. Laparoscopic operative time was longer (p = 0.015), and the hospital stay was shorter (p<0.001). Laparoscopic patients had higher HRQL scores from postoperative days 3 to 365 (p<0.001), and they returned to preoperative HRQL faster (p<0.001). CONCLUSIONS: An objective HRQL instrument confirms that laparoscopic nephrectomy patients recover faster and with a higher HRQL than open surgery patients. The PRS can be modified for use after other abdominal procedures, and may prove useful for comparisons of other minimally invasive surgical techniques.     

Health-related quality of life after Ivor Lewis esophagectomy

Purpose

Transthoracic Ivor Lewis esophagectomy is a surgical standard therapy for esophageal carcinoma. The aim of this study was to assess health-related quality of life (HRQL) in mid- and long-term survivors.

Methods

Patients with cancer-free survival of at least 12 months after esophageal resection for cancer were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and esophageal cancer-specific (QLQ-OES18) quality of life (QOL). A numeric score was calculated in each conceptual area and compared with reference data.

Results

One hundred forty-seven patients completed the self-rated questionnaires. They were 121 men and 26 women with a mean age of 63.4 (21–83) years; median FU was 39 (12–139) months. Global health status, functional scales, and symptom scores were significantly reduced compared with healthy reference populations. Also, there was no significant impact of tumor histology, neoadjuvant treatment, minimally invasive approach, or duration of follow-up on HRQL. However, more than half of the patients reported a HRQL similar to that of the healthy reference population.

Conclusions

Despite the major psychosocial and physiological impacts of the disease, more than 50 % of mid- and long-term survivors of the Ivor Lewis procedure for esophageal cancer have a HRQL similar to that of the healthy reference population.     

Intracranial neoplasms during the first year of life

During a 7-year period, from January 1976 to December 1982, 470 brain tumors were treated at the Hospital de Ni?os Ricardo Gutierrez in Buenos Aires, 40 of which occurred in infants under 1 years of age. Diagnosis was at best tentative because most cases were referred on account of symptoms and nonspecific signs, e.g., macrocephaly, vomiting, and altered behavior. The supratentorial location was predominant over the infratentorial, with a ratio of 4:1. Craniotomies with resection of tumor were performed on all but four infants. Optic chiasm pilocytic astrocytoma, superficial brain astrocytoma, and choroid plexus papilloma were the most common histologic types. Thirty-three infants (80%) were found to have hydrocephalus complicating the brain tumor, but only 15 of them were shunted, because 4 infants died, and in 14, hydrocephalus remitted after the operation. After 2-9 years of postoperative observation, 16 infants (40%) live tumor-free and have normal neurological examinations, 5 (12%) suffer moderate deficits, and 19 (48%) have died.     

Health-related quality of life of trauma patients after intensive care: a 2-year follow-up study

Purpose  

This study aimed to assess the health-related quality of life (HRQOL) in trauma patients 2 years after discharge from an intensive care unit (ICU) in Zunyi, China, and to investigate the possible determinants of HRQOL.     

Health-related quality of life and psychosocial consequences after mild traumatic brain injury in children and adolescents

BACKGROUND: Little is known about the course of health-related quality of life (HRQOL) and functional outcome parameters in children and adolescents with TBI. In addition, a neuropsychological screening instrument would be useful for routine clinical care. OBJECTIVE: To describe health-related quality of life and psychosocial consequences following mild traumatic brain injury (TBI). METHODS: One chose a prospective, longitudinal design (two measurement time points). Methods included a telephone interview and a questionnaire, which was mailed to the parents whose children (older than 4 years of age) were admitted (with TBI) to a collaborating hospital. In addition, a feasibility study for screening children for cognitive side effects, attention and memory tasks was conducted. A group of 59 parents filled out questionnaires assessing health-related quality of life (KINDL), behavioural problems (SDQ) and health status (FS-II-R). Ten families participated in the feasibility study. RESULTS: Results indicated that HRQOL, behavioural problems and health status remained stable over time. Compared to the reference groups, no significant differences in HRQOL were noted. Thirty per cent of the children screened were classified as being cognitively impaired. CONCLUSION: Mild TBI resulted in no decline in the children's health outcome after injury. The cognitive screening approach proved itself to be a useful instrument for routine clinical care.     

Health-related quality of life before and after gastrointestinal surgery.

OBJECTIVE: To assess the impact of surgical treatment on health-related quality of life (QoL) and its various dimensions in four common gastrointestinal diseases, to compare it with that of the general population, and to assess the relationship between the patient's and the surgeon's satisfaction. DESIGN: Prospective, observational study. SETTING: Tertiary care centre, Finland. PATIENTS: 131 patients, of whom 77 had cholecystectomy, 20 fundoplication, 20 incisional herniorrhaphy, 12 large bowel resection, and 2 construction of a stoma only because of unresectable colorectal cancer. INTERVENTIONS: Routine operative treatment of four gastrointestinal diseases. MAIN OUTCOME MEASURES: QoL measured by a generic 15-dimensional instrument. RESULTS: The health-related QoL improved postoperatively in the entire group. Discomfort, symptoms, and vitality were all reduced at 2 months, whereas bowel movements, eating, and usual activities had been restored at 12 months. The health related QoL was comparable with that of the general population at 12 months except for breathing and sleeping. The pattern of recovery varied among diagnostic subgroups, being most improved in patients operated on for biliary disease, those aged 60 years or younger, women and otherwise previously healthy patients. There was a close agreement between the patient's and the surgeon's opinion of outcome. CONCLUSIONS: Gastrointestinal surgery improves quality of life. Separating a generic health-related QoL measure into dimensions allows a more appropriate estimation of quality of life than a single index score. Because some dimensions were made worse soon after operation and some were restored slowly, a minimum 12-month follow-up may be needed to assess the effect of gastrointestinal surgery on health- related QoL.     

Health-related quality of life after retroperitoneoscopic and hand-assisted laparoscopic nephrectomy

BACKGROUND AND PURPOSE: The assessment of postoperative recovery typically involves the use of measures that are open to bias. Whilst there has been some work done on the short-term postoperative recovery comparison for hand-assisted laparoscopic nephrectomy (HALN) and retroperitoneoscopic nephrectomy (RPN), to our knowledge, this is the first study to look at long-term health outcomes for these two procedures. This study sought objectively to compare long-term postoperative health-related quality of life (HRQoL) after retroperitoneoscopic and hand-assisted transperitoneal laparoscopic nephrectomy undertaken for renal pathology. This was achieved by both reviewing perioperative data from medical records and by using the SF-36 questionnaire postoperatively. PATIENTS AND METHODS: Patients who had undergone elective retroperitoneoscopic (N = 19) or transperitoneal HALN (N = 32) between 2001 and 2004 at our institution underwent objective HRQoL assessment via a validated telephone questionnaire (SF-36) and by review of postoperative data from the medical records. This survey was administered between 3 and 6 months after surgery. The data then underwent statistical analysis using the paired Student's t-test. RESULTS: Perioperative data showed no significant difference in the postoperative complication rate in the two groups. The HRQoL scores gathered from the SF-36 questionnaire gave mean scores of 67.4 and 68.5 for the HALN and RPN groups, respectively (100 represents maximum quality of life). This difference was not statistically significant. CONCLUSIONS: This is the first study to look at long-term (mean follow-up 6 months) health outcomes for patients undergoing RPN and HALN. The results show no greater long-term health benefit for one procedure over the other. This finding supports the data in the literature on the benefits of HALN over RPN in terms of a less protracted learning curve, greater technical ease, fewer intraoperative complications, and consequently reduced operating times with no loss of the long-term health benefit that is traditionally associated with the standard laparoscopic technique.     

Health-related quality of life after radical prostatectomy or radiotherapy

PURPOSE: We compared general and disease specific health related quality of life (QOL) after surgery and radiotherapy for prostate cancer. MATERIALS AND METHODS: We performed a retrospective survey of patients treated between 1992 and 2001. General and disease specific health related QOL were assessed by the SF-36 and the University of California-Los Angels Prostate Cancer Index (UCLA PCI). We mailed questionnaires of QOL survey and obtained from 143 and 73 men who treated surgery and radiotherapy. The median ages of surgery and radiation group were 70.9 and 79.2 years old, and the median periods after treatment were 2.7 and 2.0 years, respectively. RESULTS: Physical function, role physical, social functioning and mental health were higher score in surgery group than radiation group, however, general health perceptions was higher in radiation group among SF-36. Surgery group had worse urinary function and better sexual function compared with radiation group. Multi-variable analysis showed that scores of social functioning, mental health and sexual function were most influenced by each modality, the scores of physical function, role physical, urinary function and sexual bother were most influenced by age, and the score of general health perceptions and body pain was most influenced by the existence of recurrence. CONSIDERATION: This cross-sectional survey cleared the differences of QOL after surgery and radiotherapy, and the influences of each modality. However, because of difference in background of each group, longitudinal investigation will need to aid patients in the decision making process.     

Health-related quality of life after lung volume reduction surgery

Many studies have demonstrated short-term physiologic benefits and improvements in various measures of health-related quality of life (HRQOL) after lung volume reduction surgery (LVRS). However, LVRS involves short-term risks of morbidity, disability, and mortality. Few reports describe the long-term effects of LVRS on patients with emphysema. Rational decision making about LVRS depends on whether the expected improvement in quality of life from LVRS outweighs the expected disability and morbidity and the potential mortality from the procedure. This report describes the HRQOL and survival outcomes of patients with emphysema after LVRS.